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The following summary highlights the latest information from the 2025 American Heart Association Emergency Cardiovascular Care guidelines as they relate to lay rescuer CPR. Just like in previous updates, the goal of these guideline changes is simple: improve survival by improving early recognition, high-quality CPR, and early defibrillation. For out-of-hospital cardiac arrest, survival rates depend heavily on what happens in the first few minutes. The 2025 ECC updates continue to emphasize that early action by lay rescuers is what saves lives. Many of the changes you’ll see focus on improving CPR quality, reducing delays, and removing the barriers that prevent people from stepping in to help. Let’s begin with initiation of resuscitation for adults. The ECC continues to reinforce the importance of CPR with breaths in adult cardiac arrest. For trained rescuers who are able to provide ventilations safely, compressions and breaths should be delivered together. If a rescuer is not trained or does not have the ability to give breaths, hands-only CPR can be used, as providing compressions alone is at least far better than doing nothing at all. Whenever feasible, and without delaying chest compressions, CPR should be performed where the person is found, as long as high-quality CPR can be delivered safely and effectively. It’s preferred that the patient be in the supine position, meaning on their back, on a firm surface, since firm surfaces improve compression depth and effectiveness. Delays caused by unnecessary movement of the patient are associated with worse outcomes. So, when possible, chest compressions should be performed with the patient’s torso positioned approximately at the level of the rescuer’s knees, as this positioning has been shown to improve compression depth. Rescuers may also consider placing their dominant hand on the sternum when performing compressions, which may further improve overall CPR quality. The key takeaway is this: don’t delay chest compressions. If high-quality CPR can be delivered safely where the patient is found, then begin it immediately. The 2025 guidelines also address an important barrier to public access defibrillation, particularly for women. Evidence suggests that the need to expose the chest may contribute to lower rates of AED use in females. While proper pad placement is always preferred, current evidence shows that successful defibrillation can still occur even when pad placement is not perfect. Because of this, it’s reasonable to apply AED pads directly to the skin by adjusting clothing or undergarments rather than removing them completely. The priority remains rapid pad placement and early defibrillation, while maintaining patient dignity and reducing hesitation that can delay the care. For conscious adults with severe foreign body airway obstruction, rescuers should perform repeated cycles of 5 back blows followed by 5 abdominal thrusts until the object is expelled or the person becomes unresponsive. This sequence reflects evidence suggesting that the back blows may be more effective and cause fewer injuries than abdominal thrusts alone. In special circumstances—such as late-stage pregnancy or when abdominal thrusts are impractical—chest thrusts should be used instead. For adults and children in cardiac arrest following drowning, CPR with breaths should be started before AED application. Drowning-related cardiac arrest is typically hypoxic in nature, meaning oxygen deprivation is the primary issue. Early ventilations are critical, and applying an AED first may delay the initiation of effective CPR with breaths, especially since shockable rhythms are less common in these cases. A small change for a foreign object embedded in the eye, we now only cover the affected eye. The change is to prevent increased anxiety from the patient not being able to see. When caring for a person showing signs of shock who remains alert, it is reasonable to place or maintain them in a supine position- again, meaning on their back. If the person is at risk for airway obstruction—such as decreased alertness or active vomiting—or if they cannot be continuously monitored, it is reasonable to place them in the recovery position, or on their side. In situations where there is no evidence of trauma or injury, such as simply fainting or dehydration, some studies show that raising the feet about 6 or 12 inches actually still may be beneficial. The 2025 ECC CPR guideline updates continue to reinforce a simple but powerful message: early recognition, early CPR, and early defibrillation- those are the things that save lives. These updates are designed to improve CPR quality, reduce delays, and remove the barriers that prevent rescuers from acting—whether that rescuer is a parent, a bystander, or a professional. Guidelines will continually evolve as new science emerges, but the mission remains the same: recognize the emergency, take action, and do the best you can. CPR doesn’t need to be perfect to save a life. And, doing something is always better than doing nothing. It’s going to make you confident, it’s going to make you informed, and that makes a measurable difference. Thank you for taking the time to review these important updates, and for your continued commitment to lifesaving care.
In this lesson, we'll go over the most important updates from the 2025 American Heart Association Emergency Cardiovascular Care guidelines for lay rescuers — that means everyday people like you who may need to help in an emergency.
The goal of these updates is simple: help more people survive cardiac arrest by acting fast. When someone's heart stops, every second counts. The 2025 guidelines focus on making CPR easier to do, reducing delays, and encouraging more people to step in and help.
Starting CPR in Adults
When an adult collapses and is unresponsive, the most important thing you can do is start CPR right away. If you know how to give rescue breaths, you should give both compressions and breaths. But if you're not comfortable giving breaths, don't let that stop you — hands-only CPR is still much better than doing nothing at all.
Start CPR where the person is. Moving them wastes valuable time. Lay them on their back on a hard, flat surface — a firm surface helps your compressions work better. Try to kneel beside them so their chest is about level with your knees, as this helps you push down with the right amount of force. You can also try placing the hand closest to their head on the center of their chest first, as this may help improve the quality of your compressions.
Using an AED on Female Patients
An AED, or automated external defibrillator, is a device that can reset the heart with an electric shock. One barrier that has been identified is that people sometimes hesitate to use an AED on a woman because they feel uncomfortable exposing her chest.
The 2025 guidelines want to clear this up: you do not need to fully remove clothing to use an AED. Simply move clothing or undergarments aside to place the pads directly on the skin. The pads don't have to be in the perfect spot to work. Getting the AED on quickly and delivering a shock is what matters most. Always prioritize speed while being respectful of the patient's dignity.
Helping Someone Who Is Choking
If an adult is conscious and choking — meaning something is stuck in their airway and they cannot breathe, cough, or speak — here is what to do. Give 5 firm back blows between the shoulder blades, then follow with 5 abdominal thrusts. Keep repeating this cycle until the object comes out or the person goes unconscious.
Research shows that back blows can be more effective and safer than abdominal thrusts alone, which is why this combination approach is now recommended.
If the person is pregnant or if abdominal thrusts are not possible for any reason, use chest thrusts instead.
Cardiac Arrest After Drowning
If someone has gone into cardiac arrest after drowning, start CPR with breaths before reaching for an AED. Drowning cuts off oxygen to the body, so getting air into the lungs is the first priority. An AED is less likely to help initially in these cases because the heart rhythm involved in drowning emergencies is usually not one that can be shocked back to normal.
Eye Injuries with an Embedded Object
If something is stuck in a person's eye, cover only the injured eye — not both. Covering both eyes can make the person feel panicked and disoriented. Keeping the uninjured eye uncovered helps them stay calm and aware of what's happening around them, while still preventing further injury to the injured eye.
Caring for Someone in Shock
If someone is showing signs of shock — such as pale or clammy skin, weakness, or dizziness — but is still awake and alert, have them lie flat on their back.
If they seem drowsy, are vomiting, or you can't keep a close eye on them, roll them onto their side instead. This is called the recovery position, and it helps keep their airway clear.
A Unified Chain of Survival
The 2025 guidelines now use one Chain of Survival for everyone — infants, children, and adults. Think of it as a step-by-step path to survival: recognize the emergency, call for help, start CPR, use an AED, and keep going until professional help arrives. Each link in that chain matters, and you are one of those links.
Closing Thoughts
The message behind all of these updates is simple: act fast, do your best, and don't be afraid to help. You don't have to be a medical professional to save a life. CPR doesn't have to be perfect — it just has to happen. The more confident and informed you are, the more of a difference you can make.